Monday, April 13, 2009

It's been a long time since newFNP has been on the business end of a cytobrush. A year, in fact. But today was the day for newFNP to go from provider to patient and shimmy down the table into the stirrups for her annual exam.

When newFNP was in training, it was one of her articulated goals to perform the pap well, with the least amount of discomfort possible. NewFNP has achieved that goal. Her patient frequently tell her that they barely felt a thing - it makes newFNP so proud.

In order to achieve her gingerly executed pap exams, newFNP uses the cervical spatula and mascara wand combo and performs 1/2 - 1 turn of each. She goes from 12 o'clock to 6 o'clock with the spatula and makes a turn with the brush adequate to touch on most areas of a parous cervix. If she sees an area of suspected abnormality, she gives that a swipe as well. Throughout the process, she uses a light touch.

NewFNP's OB/GYN, on the other hand, uses the broom cytobrush, aka the cervical pitchfork, and makes about 75,000 full-force turns with that SOB. She clearly does not believe in the light touch and her "a little cramping here" warning is an understatement indeed. But fine. It last for six seconds and is over.

What is not over is the wait for newFNP's diagnostic mammogram.

NewFNP is certain that whatever is embedded her breast tissue is a fibroadenoma. She is certain that it is not cancer. But now she has to have a boob and metal sandwich because the seed of doubt has been planted and her OB/GYN encouraged her to get that frigging thing done without delay. And she's kind of pissed because of course it will be nothing yet she will have had to have her never-lactated, full-density breast all squished up in order to have the reassurance.

Ouch.

And nothing makes a lady feel old - prematurely old - like having a goddamned mammogram.

Saturday, April 11, 2009

When newFNP decided to become an NP, it was really because she wanted to take care of patients in a community health setting.

Done.

So when that gig burned her out, she looked around to see what else was out there. Her research position just happened to be waiting for her. Serendipity.

So now newFNP alternates between mellow, organized, important work days and hectic, clusterfucked, important work days. It's pretty cool.

And that is a pretty cool part of being a health care professional.

We have options.

Both positions have their positive aspects and their negative aspects.

At the community clinic, newFNP practices independently. She is an authority on certain aspects of care. She makes connections with patients and nurtures those connection as best she can. Yet she is expected to see 30 patients daily. Her patients wait hours to see her. And did she mention already the utter clusterfuck in regards to organization (or a lack thereof)?

At the research clinic, newFNP is really, truly treated well by her supervisor. She has more than adequate time with each of the research participants. She is learning about conducting research in an academic environment in which doing things correctly is the respected and expected modusoperandi. She is learning a lot about drug addiction and is appreciating the importance of discovering new treatments for it as she meets with and learns about her patients and their lives. And there is a crazy delicious burrito stand mere footsteps away. Yet she makes no independent decisions, which, for newFNP is kind of a drag. That's the only real downside. Perhaps that will come in time.

As soon to be NP grads are hitting the job market, newFNP would offer this speck of advice: take the tough job first. Work in an environment that challenges you to become a better, more skilled provider. Learn. Sweat. Make mistakes. And, after a few years, look around and see what is out there.

Monday, April 06, 2009

NewFNP long ago gave up her white coat. Too stuffy. Too many cheaply sewn buttons falling off and too little desire to mend. Too much unflattering hip-spread look. Plus, it spent quite a while in the cargo area cum unwanted goods graveyard of her car and newFNP kind of just forgot about it. She now just rocks whatever outfit she's rocking that day and, for the most part, it's all good.

Imagine, then, newFNP's chagrin when she finished a pelvic exam and noticed that her right sleeve felt a little heavy as she exited the room.

She glanced down and noted a big glob of speculum jelly adorning the sleeve of her crisp celery-colored J. Crew cashmere sweater.

Son. Of. A. Bitch.

Quickly and with a slight shudder, newFNP shut down the horrifying thoughts racing through her mind and told herself, again and again, that the speculum jelly now seeping through the soft cashmere yarn and quite possibly tickling her silky smooth wrist skin was, in fact, sterile. It was leftover jelly from the tray which newFNP uses to lubricate the speculum, not jelly from the used speculum itself.

It was from the tray. It was tray jelly. Not speculum jelly. Tray jelly.

No matter the source, newFNP was none too keen on having jelly on her cashmere. She washed it off, scrubbed off her wrist and - with it - her morning dab Fresh 'Sugar' fragrance, rolled up her sleeves and went about her day.

This blog is for new NPs or NP students who want some real 411 on the life of a new practitioner. A new practitioner in a busy, understaffed, urban community health clinic in a major metropolitan area. Oh, and newFNP swears while writing and, sometimes, while working although she tries to keep those swears to herself. Consider yourself warned.